Vitamin D3-5

The Vitamin D Newsletter
More Vitamin D Studies of Interest
March 14, 2010

The mainstream American press is ignoring much of the recent Vitamin D
scientific literature. I suspect newspaper editors have decided that too
many favorable Vitamin D stories run the risk of repeating the folic acid,
beta-carotene and vitamin E affairs, when early epidemiological research was
not routinely substantiated by later randomized controlled trials. If the
press has made that decision, then this newsletter is your best source of
information on new Vitamin D science.

*Genetics, as well as dose, determine response to vitamin D supplements.*

Your vitamin D blood level depends entirely on how much you take or how
often you sunbathe, right? Wrong. Prior studies of identical twins show that
about 25 -50% of the variation of Vitamin D levels depends on genetics. In
July, researchers at the University of Toronto discovered the heritability
of 25(OH)D is probably mediated through the Vitamin D binding protein
(VDBP).

Fu L, Yun F, Oczak M, Wong BY, Vieth R, Cole DE. Common genetic variants of
the vitamin D binding protein (DBP) predict differences in response of serum
25-hydroxyvitamin D [25(OH)D] to vitamin D supplementation. Clin Biochem.
2009 Jul;42(10-11):1174-7.<http://list.netatlantic.com/t/51077657/90576270/126139/0/>

One of the common emails I get (and I’m sorry I can’t answer individual
emails) is “I am taking 5,000 IU per day but my blood level is only 35
ng/ml.” What should I do? This study helps answer such questions. You
probably inherited a tendency to not respond to higher doses of Vitamin D.
Simply take a little more and get your blood tested again in 3-4 months.

Also, don’t forget your weight. Does it make sense that if you weigh 300
pounds, you need more vitamin D than a 3 pound baby? If that makes sense to
you, congratulations, it has not made sense to any of the five Food and
Nutrition Boards (FNB) that have convened and issued recommendations to
Americans over the last 60 years; they have all recommended the same 200
IU/day dose for infants and young adults, no matter how much the adults
weigh.

*More researchers actually recommend that people take Vitamin D and not just
give more money to scientists.*

Researchers from Austria concluded their review paper on vitamin D and high
blood pressure by stating: “In view of the multiple health benefits of
vitamin D and the high prevalence of vitamin D deficiency, as well as the
easy, safe, and inexpensive ways in which vitamin D can be supplemented, we
believe that the implementation of public health strategies for maintaining
a sufficient vitamin D status of the general population is warranted.”

Pilz S, Tomaschitz A, Ritz E, Pieber TR; Medscape. Vitamin D status and
arterial hypertension: a systematic review. Nat Rev Cardiol. 2009
Oct;6(10):621-30.<http://list.netatlantic.com/t/51077657/90576270/126140/0/>

Good for Austria! By the way, while vitamin D may improve hypertension, it
is not the be all and end all of hypertensive disease. If your doctor can
stop your high blood pressure medication after you start taking vitamin D,
great, but I doubt that will happen. Most people will have to continue
taking their antihypertensive medication even after adequate vitamin D
supplementation, albeit sometimes at a lower dose.

While I am on the subject, remember, that vitamin D will not prevent all
cancer or heart disease or respiratory infections. True, evidence is
accumulating that it will help, but you can still develop cancer, heart
disease and respiratory infections with adequate blood levels of vitamin D.
That’s why I believe in complimentary, not alternative, medicine.

*Professor Michael Holick keeps increasing the amount of vitamin D he
recommends.*

As readers know, Professor Holick is one of the world’s foremost authorities
on vitamin D. However, after being on the 1997 Food and Nutrition Board
(FNB), he stuck with the FNB’s 200 IU/day recommendation well into the next
century. Then he slowly went to 400 IU, then 800 IU, then 1,000 IU and now
he is at 2,000 IU/day. Professor Holick is going in the right direction and
is almost there.

Cynthia K. Buccini Sunny Dispositions vitamin D deficiency may be the most
common medical problem in the world. BU Today, March 8,
2010<http://list.netatlantic.com/t/51077657/90576270/126141/0/>

*Professor Robert Heaney of Creighton University just discovered that if you
take 2,200 IU of vitamin D every day, you only have about 12 days supply of
vitamin D in your body.*

I love Robert Heaney’s papers. In a previous paper, Dr. Heaney discovered
that at blood levels of 35 ng/ml, 50% of people are using up their vitamin D
as quickly as they take it, that is, they are not storing any for future use
and suffer from chronic substrate starvation. Obviously, one wants to take
enough so the body has all it can use, which is why I recommend 25(OH)D
levels of at least 50 ng/ml. At that level, no one should have chronic
substrate starvation.

In the paper below, Dr. Heaney collaborated with two other Creighton
scientists, Dr. Diane Cullen and Dr. Laura Armas, as well as one of the
premier experts in measuring vitamin D in the world, Dr. Ron Horst of
Heartland Assays. Ron runs tens of thousands of vitamin D samples a year as
Heartland Assays performs vitamin D testing for most of the big studies and
Dr. Horst is one of the few people in the world who can accurately measure
cholecalciferol, and not just 25(OH)D.

Heaney RP, Horst RL, Cullen DM, Armas LA. Vitamin D3 distribution and status
in the body. J Am Coll Nutr. 2009
Jun;28(3):252-6.<http://list.netatlantic.com/t/51077657/90576270/126142/0/>

Anyway, in his latest paper, Dr. Heaney found that if you regularly take
2,200 IU per day, you have about 12 days supply of vitamin D in your body.
He explained, “What this indicates is that fat reserves of the vitamin are
essentially running on empty and that . . . additional vitamin D inputs are
[converted to 25(OH)D] almost immediately.” . . “The currently recommended
intake of vitamin D needs to be revised upward by at least an order of
magnitude.”

What is not known, at least by me, is what happens when cholecalciferol
intake far exceeds the body’s requirement. We know it is stored in the body,
mainly in fat and muscle, but what does the body do to control excess
cholecalciferol from building up in the body? Professor Reinhold Vieth has
written that much of it will simply be excreted unchanged in the bile, but
how does that system work exactly, to get rid of excess cholecalciferol? We
know it works because the few patients with vitamin D toxicity reported in
the literature – almost always due to industrial errors – reduce their
vitamin D levels rather quickly by simply stopping the vitamin D and staying
out of the sun.

*Zocor has no effect on vitamin D levels.*

I know several studies have found statins raise vitamin D levels but
different scientists report different findings. This paper found Zocor had
no effect of vitamin D levels while a previous paper found Crestor almost
tripled vitamin D levels. What’s the truth? I don’t know. The above study
did find that higher vitamin D levels were strongly associated with better
triglycerides and weakly associated with higher HDL (the good cholesterol)
levels.

Rejnmark L, Vestergaard P, Heickendorff L, Mosekilde L. Simvastatin does not
affect vitamin d status, but low vitamin d levels are associated with
dyslipidemia: results from a randomised, controlled trial. Int J Endocrinol.
2010;2010:957174.<http://list.netatlantic.com/t/51077657/90576270/126143/0/>

*Vitamin D lowers statin blood levels*

This study makes the point that things are often more complex than they
first appear. Almost nothing is known of vitamin D’s drug-drug interactions.
That is, how does vitamin D affect the blood level of other drugs? The below
study measured the effects of vitamin D on Lipitor levels and cholesterol
levels hours after Lipitor was given to patients taking vitamin D. The
authors were looking for drug-drug interactions and found them.

Schwartz JB. Effects of vitamin D supplementation in atorvastatin-treated
patients: a new drug interaction with an unexpected consequence. Clin
Pharmacol Ther. 2009
Feb;85(2):198-203.<http://list.netatlantic.com/t/51077657/90576270/126144/0/>

The above study found vitamin D not only lowered Lipitor levels, but vitamin
D lowered bad cholesterol levels as well. That is, the lowest bad
cholesterol levels were found in patients on vitamin D with the lowest
Lipitor levels, just the opposite of what one would think. I mean, wouldn’t
higher Lipitor levels result in lower cholesterol levels? Not when vitamin D
was taken into account. If you think my explanation of this study is
confusing, you should read the study.

*Intensive treatment with vitamin D, statins, and omega-3 fish oil reverses
coronary calcium scores.*

The below open study by Dr. William Davis and colleagues studied 45 adults
with evidence of calcified coronary arteries, treating them with high dose
statins, niacin, fish oil (not cod liver oil) capsules, and enough vitamin D
(average of about 4,000 IU/day) to obtain 25(OH)D levels of 50 ng/ml. They
found that regimen reduced coronary calcium scores in 20 patients and slowed
progression in 22 additional patients. That is, it reversed the coronary
calcification process in about half of patients and slowed its progression
in most of the rest.

Davis W, Rockway S, Kwasny M. Effect of a combined therapeutic approach of
intensive lipid management, omega-3 fatty acid supplementation, and
increased serum 25 (OH) vitamin D on coronary calcium scores in asymptomatic
adults. Am J Ther. 2009
Jul-Aug;16(4):326-32.<http://list.netatlantic.com/t/51077657/90576270/126145/0/>

Most studies have shown high dose statins on their own do not reverse
coronary arthrosclerosis, so we know it was not the statins alone. What
would vitamin D levels of 70 ng/ml do? So, if you have coronary artery
disease: ask your cardiologist about statins and niacin, take 5-10 fish oil
capsules per day, and at least 5,000 IU of vitamin D3 per day.

A word about fish oil is in order. Fish oil means fish body oil, not fish
liver oil. And, four or five capsules of omega-3 fish oil a day will do very
little if you do not limit your intake of omega-6 oils. Your ratio of
omega-6 to omega-3 is the crucial number, your want that ratio at 2 or
below, which means no chips, no French fries and no processed foods, a
difficult diet. Omega-6 oils are vegetable oils such as corn oil, safflower
oil, soybean oil, sunflower oil and cottonseed oil. Read the packages to see
what is in them and if they contain the above oils do not eat them. In
additions to taking fish oil capsules, try to eat wild-caught salmon three
times a week.

*Our group’s second paper on influenza is now the most accessed paper in the
history of Virology Journal.*

I was asked to write the paper by the editor of another journal, who then
refused it! I almost decided to scrap the paper but, in the end, submitted
it to Virology Journal. I’m glad I did.

Virology Journal: Top 20 most accessed articles for all
time<http://list.netatlantic.com/t/51077657/90576270/126146/0/>

I was glad to see that six other experts recently recommended that the
diagnosis and treatment of vitamin D deficiency be part of our national
preparedness for the H1N1 pandemic.

Edlich RF, Mason SS, Dahlstrom JJ, Swainston E, Long WB 3rd, Gubler
K. Pandemic preparedness for swine flu influenza in the United States. J
Environ Pathol Toxicol Oncol.
2009;28(4):261-4.<http://list.netatlantic.com/t/51077657/90576270/126147/0/>

In addition, I hear through the grapevine that the CDC has discovered that,
of the 329 American children who have died so far from H1N1, vitamin D
levels in the dead children were lower than in children who survived the
swine flu. Maybe something can be done to save our children by next winter?
Not to mention the 16,000 adult Americans the CDC thinks died from H1N1.

Reuters. Up to 80-million Americans have been infected with H1N1.
1/15/2010<http://list.netatlantic.com/t/51077657/90576270/126148/0/>

*Low vitamin D levels mean higher death rates in patients with kidney
disease.*

The below study is the first of its kind; Dr. Rajnish Mehrota and his eight
colleagues studied 3,000 of the 28 million U.S. adults who have chronic
kidney disease, finding those with vitamin D levels below 15 ng/ml had a 50%
increased risk of death compared to those with levels above 30 ng/ml over
the nine years of the study. These researchers from UCLA, Harvard, the Los
Angeles Biomedical Research Institute, and other institutions concluded:
“The broad public health implications of our findings cannot be
overemphasized given the high prevalence of vitamin D deficiency among
individuals with chronic kidney disease, and the ease, safety, and low cost
of maintaining replete vitamin D levels.”

Mehrotra R Mehrotra R, Kermah DA, Salusky IB, Wolf MS, Thadhani RI, Chiu YW,
Martins D, Adler SG, Norris KC.. Chronic kidney disease, hypovitaminosis D,
and mortality in the United States. Kidney Int. 2009
Nov;76(9):977-83.<http://list.netatlantic.com/t/51077657/90576270/126149/0/>

These words are music to my ears; these words are strong words, urgent
words, and, better yet, they are not my words. This is the first large study
looking at a representative group of Americans with kidney disease, before
dialysis, finding about 1/3 of them died over the 9 years of the study.
Those with low vitamin D levels were more likely to die; in fact, they were
more likely to have about every chronic disease you can think of before they
died. The average age of those with kidney disease was only 55. This is a
very important study, well written and well-conducted.

However, there is a scandal in medicine, a scandal not openly discussed in
scientific papers, one not yet reported by the mainstream press. The scandal
is this: if you are on dialysis, the chances are very high that your kidney
doctor thinks he is giving you vitamin D when he is doing no such thing and
some drug companies encourage such ignorance.

Drug companies market very lucrative activated vitamin D drugs to
nephrologists as “vitamin D.” The kidney doctors, in turn, think they are
giving vitamin D to their dialysis patients when they are doing no such
thing. If anything, the activated vitamin D analogs nephrologists use in
kidney disease will lower 25(OH)D levels by turning on the enzyme that gets
rid of vitamin D.

The ugly secret is that plain old dirt-cheap vitamin D would lower the
amount of activated vitamin D analogs needed to treat kidney disease. We
used to think it was all or none, the kidneys would either make activated
vitamin D to maintain blood calcium or the kidneys would not, as in renal
failure. However, it is not all or none; the more vitamin D building blocks
available to the diseased kidneys, the more activated vitamin D diseased
kidneys can make. And, tissues other than the kidney, such as the skin,
pancreas, adrenal medulla, and certain white blood cells, can contribute to
serum activated vitamin D levels, and probably would if they had enough of
the building block (plain old, dirt-cheap old, regular old, vitamin D).

*Just out: Vitamin D administration (plain old vitamin D) to renal dialysis
patients reduces the need for expensive vitamin D analogues, reduces
inflammation, reduces the need for medication that increases red blood
count, and improves cardiac function.*

As I was about to finish this tirade about vitamin D and kidney failure, the
below open study was published on March 4, 2010 and I ordered it. (By the
way, the Council has to pay $11.00 for every paper I get and only one paper
in ten is worth reporting on). The study below confirms what the above
authors predicted; plain old cheap vitamin D helps patients with kidney
disease.

Matias PJ, Jorge C, Ferreira C, Borges M, Aires I, Amaral T, Gil C, Cortez
J, Ferreira A. Cholecalciferol Supplementation in Hemodialysis Patients:
Effects on Mineral Metabolism, Inflammation, and Cardiac Dimension
Parameters. Clin J Am Soc Nephrol. 2010 Mar
4.<http://list.netatlantic.com/t/51077657/90576270/126150/0/>

Dr. Patricia Matias and colleagues in Portugal gave vitamin D3 to 158
patients on renal dialysis, using a sliding scale of vitamin D3
administration dependent on baseline 25(OH)D levels. Some patients got
50,000 IU per week, some got 10,000 IU per week, etc. Their dosing regimen
increased 25(OH)D levels from a mean of 22 ng/ml at the beginning of the
study to a mean of 42 ng/ml during treatment, indicating half of patients
still had levels lower than 42 ng/ml after treatment. Interestingly, most of
the patients who did not increase their 25(OH)D very much had diabetes,
suggesting the metabolic clearance (how quickly it is used up) of vitamin D
is increased in diabetes. By the way, we know the patients took the vitamin
D; the doctors gave it to them when they came in for dialysis.

The results of this study were amazing. After vitamin D administration,
parathyroid hormone, albumin, CRP (a measure of inflammation), brain
natriuretic peptide (a measure of heart failure), and left ventricular mass
index (a measure of heart function) all improved significantly. The dose of
activated vitamin D (Zemplar in this case) was reduced, and some patients
were able to stop it all together. Also, the dose of two other drugs used in
kidney failure, one to bind phosphorus and the other to raise hemoglobin,
was reduced.

It is a tragedy that drug companies sell more expensive vitamin D analogs by
having their drug salesman assure kidney doctors that the expensive vitamin
D analogues are vitamin D, even if it kills their clients. But, with the
brand new knowledge that kidney failure patients live much longer on vitamin
D, the drug companies might want to do some simple math. They might make
even more money if they kept their patients alive longer. True, they will
need less vitamin D analogues and other expensive kidney drugs every day,
but the patients may live many more days.

John Cannell, MD

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2 Responses to “Vitamin D Newsletter – March 14th, 2010”

  1. MacMadame says:

    This part made me laugh:

    I suspect newspaper editors have decided that too many favorable Vitamin D stories run the risk of repeating the folic acid, beta-carotene and vitamin E affairs, when early epidemiological research was not routinely substantiated by later randomized controlled trials.

    I know a bunch of newspaper editors and I can’t imagine them thinking like this (assuming they even know what epidemiological research is). I think it’s just that the Vitamin D story isn’t sexy enough to them.

  2. Yeah. I can’t see vitamin D research as sexy. At all.

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